If you enroll in medical coverage, you are automatically enrolled in prescription drug coverage.

*Under the HSA Plan, if more than one individual is enrolled, the family deductible must be met. Once the family deductible has been met, the plan will pay each enrolled family member’s covered expenses based on the coinsurance level. One individual may satisfy the per person out-of-pocket maximum.

Veradigm contributions to HRA and HSA Health Accounts

This overview chart shows in-network benefits only. For full details, see the Kaiser SBCs in the Resources section.

If you enroll in medical coverage, you are automatically enrolled in prescription drug coverage.

*If more than one individual is enrolled, the per person deductible applies – $3,300 in 2025 and $3,400 in 2026. Once the family deductible has been met, the plan will pay each enrolled family member’s covered expenses based on the coinsurance level. However, one individual may satisfy the per person out-of-pocket maximum.

Veradigm contributions to HRA and HSA Health Accounts

All Veradigm Medical Plans cover in-network preventive care services, such as annual check-ups, immunizations and age appropriate screenings at 100 percent.

You pay nothing for these services that help keep you healthy:

• Well-adult exams
• Well-child exams
• Child immunizations
• Age and gender-related screenings
• Flu shot (once a year)

Preventive care received out-of-network is not covered.

Preventive care services covered under the Affordable Care Act

Preauthorization is the determination of a medical necessity review, which is a review process that determines whether or not certain medical services or medications are necessary and will be covered by our plan. This determination for approval by your medical insurance provider is based on evidence-based medicine guidelines. Its primary purpose is to help assure you get the right care, at the right time, in the right place and at the right cost.

Your in-network provider is responsible for initiating the preauthorization process with your medical insurance provider. You are responsible to make sure your provider has received the preauthorization.

If you’re an active associate considering enrolling in Medicare, it’s important to understand how Medicare impacts medical coverage for you and your spouse or domestic partner:

• If you and your spouse are both age 65 or older. If you continue medical coverage under Veradigm, Medicare pays secondary benefits to both you and your spouse. The Veradigm plan pays primary benefits. You’re not required to enroll in Medicare at age 65 because you already have employer-provided coverage in place.
• If one of you (you and your spouse) is under age 65 and the other is over age 65. If you continue medical coverage under Veradigm, Medicare pays secondary benefits to the participant who is 65 or older. You’re not required to enroll in Medicare at age 65 because you already have employer-provided coverage in place.
• If you’re under age 65 or over age 65, and your domestic partner is age 65 or older. If you continue medical coverage under Veradigm, Medicare pays primary benefits for your domestic partner. The Veradigm plan pays secondary benefits regardless of whether your domestic partner enrolls in Medicare. This means that the Veradigm medical plan will only pay secondary benefits after what Medicare would pay, regardless of whether your domestic partner is enrolled in Medicare.
• If you’re age 65 or older and your domestic partner is under age 65. For you, if you continue medical coverage under Veradigm, Veradigm pays primary benefits for you and Medicare pays secondary benefits. For your domestic partner, the Veradigm plan continues to pay primary benefits.

Can you have COBRA as well as Medicare?

If you leave Veradigm and continue medical coverage through COBRA and are Medicare-eligible, COBRA benefits depend on when you become entitled to Medicare:

• If your Medicare benefits (Part A or Part B) become effective on or before the day you elect COBRA coverage, you can continue COBRA coverage as well as having Medicare. This is true even if your Part A benefits begin before you elect COBRA but you don’t sign up for Part B until later. In this situation, Medicare is always primary to COBRA coverage.
• If you become entitled to Medicare after you’ve signed up for COBRA, your COBRA benefits cease. (But if COBRA covers your spouse and/or dependent children, their coverage may be extended for up to 36 months because you qualified for Medicare.)

If you enroll in one of the BCBS medical plans, the prescription drug benefits will be administered by Optum Rx.

GLP-1s and your deductible: GLP-1s for weight loss are Tier 2 Preferred brand drugs for all BCBS plans. If you’re enrolled in the HSA plan, you’ll need to meet your deductible before coinsurance applies for Tier 2 Preferred brand drugs.

Maintenance medications (prescriptions taken regularly over an extended period to manage ongoing health conditions) must be filled through CVS or Optum mail order pharmacy.

*Preventive medications must be filled through CVS or Optum mail order pharmacy. You can obtain specific preventive medications in-network with no cost-share as follows:

• There is no cost for medications Optum Rx’s Preventive drug (ACA) list for all plan participants.
• Additionally, for Optum Rx HSA Plan participants, when you purchase other preventive medications listed on Optum Rx’s 2025 Preventive Drug list, your coverage will be 100% with no deductible or coinsurance applied.
• To see the Optum Rx’s lists of preventive medications, visit optumrx.com. For cost details regarding preventive medications and the Optum Rx Premium Formulary, contact Optum Rx at 1-844-368-0693.

Generic drugs usually cost less than brand name drugs.

Generic drugs are reviewed by the FDA to ensure that they work the same as the brand-name drug in dosage, safety, quality, performance, strength and usage.

To help keep prescription drug costs in check, prescriptions are automatically filled with a chemically equivalent generic drug, if available and appropriate. If you choose a brand drug when a generic is available, you will pay the difference between the brand medication and the generic, plus the coinsurance. However, if your doctor indicates “Dispense as Written” on your prescription because the brand is medically necessary, you will receive the brand drug and only pay the brand copay.

Note: If you choose a brand drug when a generic is available, you will pay the difference between the brand medication and the generic, plus the coinsurance.

Preferred brand drugs

Brand-name drugs on the Optum Rx preferred list are less expensive than using a non-preferred drug.

Non-preferred brand drugs

Brand-name drugs that are not on your preferred list may cost you more, even if they are recommended by your doctor.

Long-term medications, also known as maintenance drugs, are taken on a regular basis (three months or longer) to treat conditions such as high cholesterol, high blood pressure and asthma.

A specialty drug is a medication used to treat chronic, complex conditions like multiple sclerosis, hepatitis C and cancer. Specialty medications can include oral solids, or can be injected, infused or inhaled and may require special handling, such as refrigeration.

Certain preventive medications and supplies are covered at no cost to you and are not subject to meeting a deductible. These medications require a prescription and are subject to certain eligibility requirements. Check with your medical plan provider for details.

With the Cigna DPPO plan:

• You can go to any dentist but typically spend less when you visit a Cigna in-network dentist.
• You do not have to choose a network dentist ahead of time, you choose a dentist when you are ready to make an appointment.
• No ID Cards needed. Your Group Number (3339080) is all your dentist will need to confirm your dental coverage and submit a claim.

DPPO in-network services are based on the fee amount the DPPO provider has agreed to charge for covered services. An in-network provder will not bill you for charges in excess of the in-network negotiated fees.

DPPO out-of-network services are based on the reasonable and customary (R&C) amount that Cigna determines using the lowest of either the dentist’s actual charge, the dentist’s usual charge, or the charge of most dentists in the same geographic area for the same/similar service. Out-of-network dentists may bill you for amounts that exceed the R&C fee limit.

With the DHMO plan:

• There are no deductibles to meet.
• Your share of out-of-pocket costs is listed on your Patient Charge Schedule (PCS).
• Referrals are required for some specialty care services. Exceptions are pediatric dentists for children under 7, orthodontics and endodontics.
• There are no dollar maximums, no matter the amount of your covered expenses.
• There are no claim forms to file and no waiting periods for coverage.
• You will receive a dental card

When you enroll in the Cigna DHMO plan, you’ll be assigned a dentist from the Cigna Dental Care Access Plus network who will be your source for basic care, advice and referrals to other in-network specialists, if you need them. If you want to select a different dentist from the network, you can call Cigna to make a switch.

Under the DHMO, Cigna allows your network dentist to charge a certain amount. Then you pay a fixed portion of that cost, as listed in the Patient Charge Schedule (PCS). The DHMO pays the rest.

Out-of-network benefits are not offered with the Cigna DHMO plan (except for emergencies or where required by law).